Adherence to Prophylactic Antibiotic Guidelines Among Medicaid Infants With Sickle Cell Disease

Infants with sickle cell disease have as much as a 100-fold increased rate of pneumococcal infection compared with the general population.1 Penicillin prophylaxis has been shown to reduce the risk of pneumococcal sepsis by 84%.2 Thus, sickle cell management guidelines include twice daily penicillin prophylaxis for infants and young children.3 While studies have described low rates of adherence to prophylactic antibiotic guidelines in older children, little is known about initiation of prophylactic antibiotics in early infancy, a period of great vulnerability.4 We describe adherence to guidelines for initiation of prophylactic antibiotics in a cohort of Tennessee Medicaid infants with sickle cell disease and examine risk factors for non-adherence to guidelines.